Introduction

Article Outline

• Copyright

This edition of Seminars in Colorectal Surgery is devoted to the understanding and treatment of hemorrhoidal disease. Articles on the history and etiology of the hemorrhoids provide a chronicle of the evolution of ideas and treatment through centuries. Many of the current treatment modalities are more sophisticated techniques than were described in ancient times. For the trained colorectal surgeons, articles on anatomy, diagnoses, and etiology may be a review but, for the primary care physicians or young surgeons, these articles provide the background information on which current diagnosis and treatment is based.

The next several articles describe various treatment options, in the office and outpatient setting, as well as the use of the newer devices available to treat hemorrhoids. These new devices such as the Ligasure, Harmonic Scalpel, PPH Stapler, and radiofrequency ablation devices were developed as physicians pursue the “Holy Grail” of the treatment of hemorrhoidal disease, which is a painless hemorrhoidectomy. This is not yet attainable. Although there is some overlap in these articles, the authors have reviewed the current literature and give their considered opinion on the proper use of these modalities.

Finally, all physicians see patients in severe pain from hemorrhoidal crisis or with disabling hemorrhoid symptoms in complicated situations such as pregnancy, inflammatory bowel disease, portal hypertension, and cirrhosis, or the immunosuppressed patient. Treatment and recommendations are made based on best evidence.

I hope readers of this issue will find it timely and a good reference compendium. My personal thanks goes out to the authors for their efforts and punctuality.